文章摘要
孔祥勇,陈鸿武,余晓凡,马礼坤.主动脉内球囊反搏对暴发性心肌炎引起难治性心源性休克患者的临床疗效[J].中国临床保健杂志,2019,22(5):584-587.
主动脉内球囊反搏对暴发性心肌炎引起难治性心源性休克患者的临床疗效
Effects of IABP on fulminant myocarditis complicated with refractory cardiogenic shoc
投稿时间:2019-04-15  
DOI:10.3969/J.issn.1672-6790.2019.05.003
中文关键词: 心肌炎  休克,心源性  主动脉内气囊泵  多器官功能衰竭  血流动力学
英文关键词: Myocarditis  Shock,cardiogenic  Intra-aortic balloon pumping  Multiple organ failure  Hemodynamics 〖FL
基金项目:
作者单位E-mail
孔祥勇 中国科学技术大学附属第一医院安徽省立医院心血管内科,合肥 230001 kxyong1234@163.com 
陈鸿武 中国科学技术大学附属第一医院安徽省立医院心血管内科,合肥 230001  
余晓凡 中国科学技术大学附属第一医院安徽省立医院心血管内科,合肥 230001  
马礼坤 中国科学技术大学附属第一医院安徽省立医院心血管内科,合肥 230001 lkma119@163.com 
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中文摘要:
      目的 探讨主动脉内球囊反搏(IABP)对暴发性心肌炎引起难治性心源性休克的临床疗效及局限性,分析其可能的影响因素。方法 纳入我院近3年收治的暴发性心肌炎引起严重心源性休克的患者共5例,患者入院后积极药物治疗的同时,急诊置入IABP,分析IABP置入前后生命体征、血流动力学的变化以及血管活性药物的应用情况,评价IABP对患者的治疗效果。结果 5例患者入院时均存在严重心源性休克,合并肝肾功能损害,4例患者氨基末端脑钠尿肽(NT-proBNP)明显升高,4例患者入院时血气分析提示严重酸中毒。有2例患者导管室置入IABP同时做了冠脉造影检查正常,所有患者IABP置入后血流动力学均无明显改善(P>0.05),均在短时间内行心肺复苏抢救,血管活性药物不断加量,相比较IABP置入前差异有统计学意义(P<0.05),其中1例联合使用了静动脉体外膜肺氧合(VA-ECMO);5例患者中有3例抢救无效死亡,1例自动出院。结论 IABP可有效改善泵功能衰竭,但对于引起严重心源性休克的心肌炎患者临床效果不佳。此类患者应该早期应用ECMO治疗降低死亡率。
英文摘要:
      Objective To explore the clinical efficacy and limitations of intra-aortic balloon pumping (IABP) in patients with fulminant myocarditis complicated with refractory cardiogenic shock and analyze the possible influencing factors.Methods A total of 5 patients with fulminant myocarditis complicated with serious cardiac shock were merged into the hospital for nearly three years.Each patient′s clinical characteristics are basically the same,IABP was implanted at the same time of positive drug rescue emergency.Through analyzed the changes of vital signs,hemodynamic and vascular active drugs before and after the application of IABP,to evaluate the effect of IABP on these patients.Results All of the 5 patients had severe cardiogenic shock on admission,combined with liver and kidney function damage,4 patients had significantly increased NT-proBNP,and 4 patients had severe acidosis after admission.After implantation of IABP,hemodynamics was not significantly improved in all patients (P>0.05),and cardiopulmonary resuscitation was performed within a short time.Three of the five patients died and one discharged automatically.Conclusion The clinical of IABP effect is not good for patients with myocarditis complicated with severe cardiogenic shock.ECMO should be used to reduce mortality in these patients at an early stage.In case of fulminant myocarditis complicated with cardiogenic shock,multiple organ dysfunction caused by delayed treatment time is one of the factors influencing prognosis.
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